Tue December 11, 2012

The Deadly Return Of Whooping Cough

I'm Michel Martin and this is TELL ME MORE from NPR News. In a few minutes we'll hear more about singer and reality show star Jenni Rivera. She died in a private plane crash over the weekend. We'll hear about why she was such a big star on both sides of the U.S.-Mexico border. That's coming up.

But first, among other things, many of her fans admired about her, Jenni Rivera was a mom of five and on this program we check in every week with a diverse group of parents for their common sense and savvy parenting advice.

Today we want to talk about a troubling issue in children's health, pertussis, or as it's commonly known, whooping cough. It's thought of by many parents and even some doctors as one of those old-timey diseases that we don't have to worry about anymore, but whooping cough cases are on the rise. Washington State has seen close to 5,000 cases this year. Nearly every state has reported an increase in the disease, that according to the Centers for Disease Control and Prevention.

Since this is the time of year when many people are on the move and kids are getting sniffles anyway, we thought this was a good time to check in and hear about what we need to know about this.

So I'm joined now by Dr. Leslie Walker. She's a pediatrician and Chief of Adolescent Medicine at Seattle Children's Hospital. I'm also joined by Mariah Bianchi. She's a mom who suffered the loss of her infant son to the disease in 2005. She's also a nurse and she's now involved with the San Francisco Immunization Coalition.

And I welcome you both, and thank you for joining us.

LESLIE WALKER: Thank you.

MARIAH BIANCHI: Yeah, thank you.

MARTIN: And Ms. Bianchi, I do have to say I am so sorry for the loss of your child and thank you for being willing to talk about this and also for the work that you're doing in this area.

BIANCHI: I appreciate that.

MARTIN: Dr. Walker, I'm going to start with you. First of all, what is whooping cough? Why is it something that we're so concerned about?

WALKER: Well, whooping cough is a respiratory disease that can affect anybody. It's very contagious. People used to call it whooping cough because it has a whooping sound, especially when young kids with smaller airways are coughing and you cough constantly and constantly, so bad that for young kids they may not be able to catch their breath and they have respiratory problems.

For older people, people might think, oh, I've had a really terrible cough. It's lasted for 90, 100 days of constant coughing. Because their airways are bigger, they may not be in as much danger, but for younger kids it's life-threatening.

MARTIN: Why is it life-threatening in younger children? Is it because they literally can't breathe?

WALKER: Yes. They can't breathe and, you know, with the continuous coughing and the trouble it gives their lungs.

MARTIN: Why are we seeing an increase now? As we said, this is one of those things that people thought, you know, Grandma had to worry about that. We don't.

WALKER: You know, I think it's interesting because it's easy to say that it's because people aren't being vaccinated. Washington State is one of the states that has the least amount of people that get their vaccinations, but when you look at our epidemic here, we had 180 cases in 2011 in the first half of the year and now we have almost 5,000 cases. It's a 1,300 percent increase and most of those kids had the vaccine. So one of the questions is, is it the actual vaccine? We changed the kind of vaccine that we have now and it's possible that it's waning earlier. You know, after a couple of years it may be beginning to wane.

MARTIN: You've already mentioned some of the signs that people should be looking out for, so I'm going to ask you to start and then I'm going to ask Mariah Bianchi to talk about what her experience was. So Dr. Walker, just first of all, what are some of the clues that whooping cough is occurring?

WALKER: Initially it's going to seem like a cold. You know, the child will have some congestion, some coughing, fever, but the coughing will become the most prominent concern and parents will be concerned that their child isn't able to catch their breath. An infant we're really talking about - those are the kids that are most at risk.

MARTIN: Mariah Bianchi, let's pick up the thread here with you. As I understand, you had a cough while you were pregnant with your son Dylan, but he was delivered healthy. So then what happened?

BIANCHI: So really, I mean they thought exactly like what Dr. Walker had just said. They thought I had a cold and they said, oh, it'll be good. You get it now, before he's born, except that coughing had progressed and continued to get stronger and stronger until my contractions started.

And as you said, he was beautiful when he was born. He was totally healthy. He was just great, and when our pediatrician had come in to do the daily checks, it was like Dylan looks great, you sound horrible. How long have you had this cold? And I kind of explained it to him a little bit and he's like, if I didn't know better, it almost sounds like you have whooping cough.

And despite being a nurse, I had no idea what this was, and granted, this was a number of years back now, but he told me - he referred me to my primary care doctor, and so that's who I saw the day we got discharged and she said, oh, that doesn't exist. It's not around anymore. You have some lung spasms. And she gave me some medication to help open up my airways.

Well, over the next couple weeks, the cough continued to get worse. I was instructed by my doctor to continue breastfeeding and to continue, like, doing good hand-washing, which were the two things that would help protect Dylan, and that's what I did. So here I am coughing and - to the point where I'm having a hard time breathing at night and just, you know, really kind of struggling, but I'm breast-feeding every two hours and I'm taking care of this infant with a three-year-old right next to me. And so that's really when it started.

MARTIN: When did somebody figure it out? I'm so struck by what you said, as where the pediatrician said well, if I didn't know better, I would think it was this. But he just didn't believe that this was a factor in American health anymore?

BIANCHI: I think multiple people didn't know at this time. And that's what's so scary for me now, is to see that they've had more than 35,000 cases this year alone, and to see that so many babies are still dying, despite knowing now for a number of years now that it's back. But Dylan, you know, he was fine. He had frequent follow-ups with the doctor, and over the next two-and-a-half weeks they were keeping a really close eye on him. And finally, around three weeks old, my older son, my three-and-a-half-year-old, started to get a runny nose, and Dylan started to get a little bit lethargic.

And it was hard to keep him awake when I was feeding him, and they told me to use all the good strategies, tickle his feet, get him naked, all of those things they tell you to do for newborns. He just continued to be lethargic. So he never really had, you know, signs of a cold. After, you know, a day of not really being able to keep him awake, we went back to the doctor, and they said I know we just saw you two days ago, but I do hear something in his lungs. If you guys could go get a chest x-ray and go home, I'll call you with the results tonight.

So that's what we did, except Dylan never made it home. Every hour that went by progressed so quickly, that within 12 hours, he had to have a breathing tube put in, because he was unable to breathe by himself. And the next day there were signs that the infection was taking over his whole entire body. Meanwhile, the doctors didn't really know what they were treating. They didn't know that we had Pertussis. And by the next day, within 24 hours of going to the hospital for that x-ray, his heart started to fail, his kidneys started to fail and he had signs of infection throughout his whole body.

MARTIN: Oh, wow. I'm sorry.

BIANCHI: So...

MARTIN: That is awful.

BIANCHI: ...he was - yeah.

MARTIN: That's an awful - that's awful. How did they finally figure it out? I mean, was it just too late? By the time they figured out, it was just too late.

BIANCHI: Well, they had transferred him to the University of California, San Francisco for more aggressive treatment. They were thinking he would be a good candidate for a heart-and-lung bypass machine, except that the transfer was very stressful for him, and he basically went into cardiac arrest before they could even do the procedure.

They did CPR for probably 40 minutes or so, and at that point, the doctors had brought us in and, obviously, very concerned about his neurologic function and how sick he was. And we, you know, we had made that decision to stop, and he died right away. And it was - it's one of those things when you live with the guilt of giving your child a disease that kills them is something that I have to live with. But we didn't even know what he had until the autopsy reports that were mandated by the state were submitted and showed that he died of overwhelming infection due to Pertussis.

MARTIN: I was going to ask Dr. Walker to just respond to this. Can I - what do you think when you hear this?

WALKER: Well, I think it wasn't on the public radar, but I think it wasn't on the medical radar. It's a devastating story, and I think people just really believed that the vaccines were working. We had a lot of faith in vaccines. I think over time, people are realizing that vaccines do wear off, and there are people that they don't work for even when they've had them. And people are getting a little more sensitized to that, but I'm sure that the doctors, they were perplexed. They had no idea, and they must have been devastated when they realized it was a treatable illness, had it been caught earlier.

MARTIN: We're talking about a rise in Pertussis. Whooping cough is what most people know it as. It can be fatal to children. I'm joined by Dr. Leslie Walker and Mariah Bianchi. She's a nurse and a mother, and lost her child to this disease.

Mariah Bianchi, I think like a lot of people here, I'm in awe of your courage here and being able to not just face this, but then to try to go on and try to help other people avoid what you went through. What should we learn, here?

BIANCHI: Well, for me, I wish I had gotten the Tdap. It's a vaccine that you can get as an adult. It would have given me at least a chance of protecting him, if I had known about it. And I really think that even though it may not be as effective as we would like, it's still our best tool at protecting our babies and protecting each other as a community. If I had gotten it, even maybe my third trimester or as soon as he was born, or maybe he could've been protected. Maybe my three-and-a-half-year-old, who didn't have the full series yet, could have been protected, because he suffered, as well.

And I watched him go through those 90 days of coughing fits and multiple emergency room visits. And, you know, watching that happen is just so devastating, that that's the reason why I'm here. I hate to know that other people are experiencing this and going through it. But if we can know the signs and symptoms, if we can be aware and if we can recognize that, adults have a very low - less than 10 percent of adults have their Tdap vaccine. We are not doing a good job protecting each other with so few people being immunized. So to get that, to build that protection - and I think that at least gives them a better chance, until we can develop a better vaccine.

MARTIN: You know, Dr. Walker, to that end, there's a new study just published in the Journal of the American Medical Association about the Pertussis vaccine. It shows that it becomes less effective over time. Are there other ways you think that the medical community is responding to this, and are there other things that you would like people to know?

BIANCHI: Well, I would like to underscore what Mariah said: The most, single-most important thing that you can do is get the vaccine. I do think that, you know, we're talking about whooping cough and Pertussis vaccine now, but I think we have to be very vigilant and understanding about all the vaccines and many of the illnesses we thought were gone and just remembering we've got to get those vaccines, because it's not by magic that they disappeared. It's been in public health and scientific advances in finding vaccines that have helped a lot of these devastating illnesses decrease in our community.

MARTIN: Mariah Bianchi, is there a final thought you'd like to leave us with?

BIANCHI: I just want to say thank you, number one, for allowing me to come. And the second thing is just for all of the listeners today to know that we really are a community, we are - beyond our friends and family. But that we can protect each other by sharing stories, by understanding the signs and symptoms of Pertussis and being an advocate for your family, for your community and hopefully by protecting yourself by encouraging vaccinations. And, you know, having an active role in your community is one of the things that I've learned has become so important for our health and our happiness.

MARTIN: Mariah Bianchi is a nurse. She lost her infant son Dylan to whooping cough in 2005. She's now involved in efforts to bring more awareness around immunization issues. She was kind enough to join us from a studio in San Francisco. Also with us from our member station KUOW in Seattle, Dr. Leslie Walker. She's a pediatrician and chief of adolescent medicine at Seattle Children's Hospital.

Thank you both so much for speaking with us. And if I'm not out of turn here, I do hope the happiest of holidays for both of you, despite this loss.